Antenatal psychosocial assessment for reducing perinatal mental health morbidity

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

Forfattere
Austin, M. P. Priest, S. R. Sullivan, E. A.
Årstall
2008
Tidsskrift
Cochrane Database of Systematic Reviews
Volum
Sider
Background Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. Objectives To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TR‐Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008). Selection criteria Randomised and quasi‐randomised controlled trials. Data collection and analysis At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias. Main results Two trials met criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her healthcare providers plus a patient information booklet) and the standard care groups (RR 0.86 95% CI 0.61 to 1.21; 371 women). Authors' conclusions While the use of an antenatal psychosocial assessment may increase the clinician's awareness of psychosocial risk, neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes. Further studies with better sample size and statistical power are required to further explore this important public health issue. It will also be important to examine outcomes up to one year postpartum not only for mother, but also infant and family.

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Tiltaksnivå

Tidlig innsats

Tema

Psykiske vansker og lidelser

Følelsesmessige problemer

Depresjon og nedstemthet (inkl. både vansker og lidelse)

Angstproblematikk

Angst og engstelighet (inkl. både vansker og lidelse)

Foreldreferdigheter

Fødsels-/barselsdepresjon

Biologiske risikofaktorer, sykdommer og symptomer

Gravide (inkl. tenåringsmødre)

Tiltak

Psykososiale hjelpetiltak

Tiltak rettet mot gravide og barselkvinner

Aldersgruppe

Sped- og småbarn (0-2 år)

Egenskaper

Cochrane-oversikter

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